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SAN JOAQUIN COUNTY <br /> NOTIFECATION OF HAZARDOUS WAS I E DIS HARGE # <br /> HEALI & SAFETY CODE 2518 <br /> r0 .7 <br /> 4 k <br /> A. EMERGENCY LEVEL: Oi I IIIS <br /> . HS-EH LOG � � l <br /> (Circle One) il <br /> ' <br /> I <br /> B. SOURCE OF INFORMATION <br /> Name: �d'FF d ei - ' Phone: zPq 68'-3q <br /> Company: <br /> Address: OZZ <br /> Designated Employee Name: Phone: C ) <br /> Reporting <br /> Agency Name: <br /> Address: ylly Z/q <br /> C. LOCATION AND PATE OF DISCHARGE <br /> Location• Z o iy.¢� i2 - '£ <br /> Location:. <br /> Physical D 'ption) r County) Circle One <br /> Date of Discharge: 9 R'Z " r <br /> Date NocTied: 4 4 Time: <br /> D. RESPONSIBLE PERSON/BUSINESS ao <br /> 4 Name of Business: v <br /> Contact Person: �''ofr d2e.6f.✓ <br /> Teephone: <br /> Physical Address: � G <br /> Y, �-A M <br /> Mailing Address: P v. Bo ZO r 4-437-6 <br /> E. DESCRIPTION <br /> Type of Discharge: /G <br />'k Volume: /00 <br /> Chemicals: <br /> Circumstances:, G S.�l �! -5✓��5 5,,��GL F�c..d�.e�,J ?moo <br /> ons <br /> F. ACTION TAKEN <br /> 016 <br /> BQ TO Gv�/NQ PO�Qs GO G A7'�l� /�T TJ <br /> SITE DISPOSITION k <br /> ewv71•�7� <br /> r� �€ <br /> EH 22 013 (Rev.4/91) <br />